Healthcare Musings January 2010

Surfing, Swimming or Drowning:
Making the Most of the Coming Wave of Clinical Data

by Richard Noffsinger

The biggest waves are always the best and most coveted for surfing, but they also have the potential for creating the most mayhem.

Instead of salt water, the wave that I see building not too far off the horizon is made up of billions of kilobytes of clinical data, brought on by the implementation of ARRA-related health information technology measures. And this wave is enormous.

Maybe living in San Diego for two years now has registered its impact on me, but I prefer the thought of taming this big wave rather than being a victim of its awesome power.

Step One: The swell looms with more than 1 billion ambulatory care visits a year

Let me break it down. Health care touches everyone. In 2009, there were more than 1 billion visits to physicians’ offices, outpatient hospitals and emergency rooms, with each visit representing a shoebox of clinical data that’s sitting dormant, untapped, and utterly disconnected from any other clinical data that person may have generated.

There is usable data in stacks of paper files in doctors’ offices and taking up entire floors of hospitals across the country, usable data in files submitted in medical claims, data in pharmacy claims, in lab records and so on. As clinical data is created, it remains in various forms, stored as neat, isolated silos, and representing a staggering amount of untapped actionable health intelligence.

But all that is changing. ARRA provides $36 billion as incentives for physicians, hospitals and other health care providers to implement a digitized form of medical records called electronic health records or EHRs. On the surface, that’s unimpressive, because it would appear that instead of a manila folder holding the clinical data, you’ve just created a virtual folder for the data. But the implementation of EHRs is not the finish line – it’s just the first step in what will be a radical and immensely transformative era for U.S. health care.

That’s because all this data, in its digitized form, can be used together to create a truer, more comprehensive picture of individual patients, and analyzed in thousands of different ways to improve the quality of care and lower costs.

Digitized clinical data can be analyzed to prevent drug interactions, close critical gaps in care, and help health care organizations -- from health plans to hospitals to consumers directly through a personal health record – better understand the individual and collective health of their constituencies, and create highly personalized treatment regimens.

Step Two: Taming the wave with prioritization

It can be overwhelming to contemplate both the volume of approaching data and its ultimate value to the quality of health care. In fact, many companies I’ve met with – including leading health plans, PBMs and more – find themselves paralyzed by the opportunities presented by clinical analytics. Nearly any question they have about their population can be answered by the data at hand, and narrowing it down to the questions that matter most to their – or their customers’ – business is a critical step.

Is it important to know what percent of your diabetic population is adhering to treatment? Is it even more important to understand the reasons behind non-adherence so that you can build programs to address those reasons? Do you want to leverage patient data for more streamlined prior authorization processes? What potential drug contraindications for your population exist? Where are the gaps in care, and how narrowly can you personalize the corresponding treatment options?

I think you get the idea. Only clear prioritization will keep health care companies moving with the direction of data.

Step Three: Riding the wave to differentiation

Another advantage of this tidal wave of data is the potential of added differentiation. If a health care company is willing to forgo the traditional boundaries that define its business, the leveraging of clinical data can generate significant competitive points of difference and add forward-looking dimensions to their value proposition. And the use of analytics is so nascent that the first-to-market position is still open in most market segments.

Nearly any health care company responsible for a patient or provider touchpoint – from explanation of benefits to eligibility requests to filling a prescription – can use clinical data to improve the quality of care and lower costs. The challenge they face is not just when, but how to do so effectively, but one thing is certain: those who dive in quickly and with purpose will be those who have the best ride.

About the Author

Richard Noffsinger has 20 years of information technology and health care experience. He joined Anvita Health™ as the chief executive officer in 2007. Previously Noffsinger served as the president and chief operating officer of Amicore, Inc., a health care information technology company. Prior to Amicore, Noffsinger served as group industry manager, worldwide health care market for the Microsoft Corporation, where he led the company's business development team in health care. While he was at Microsoft, he directed the health care group's revenue growth through acquisitions and strategic distribution partnerships with leading IT solution providers, including the joint launch of Amicore.